From the Guidelines
The Confusion Assessment Method-ICU (CAM-ICU) is the most recommended maneuver to determine delirium, as it is a validated tool that assesses for delirium in a focused patient assessment, usually taking less than 2 minutes to complete 1. To perform this assessment, evaluate the four key features of the CAM-ICU, which include acute onset and fluctuating course, inattention, disorganized thinking, and altered level of consciousness. The importance of monitoring for delirium using a validated tool like the CAM-ICU far outweighs the nuanced differences between available tools, and the choice of instrument should be based on clinician preference 1. Other useful tools include the Intensive Care Delirium Screening Checklist (ICDSC), which assesses 4 symptoms of delirium in a focused patient assessment and 4 domains over the current and prior nursing shift 1. Regular assessment for delirium using a valid tool is a good practice statement, as recommended by the clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU 1. Early detection of delirium is crucial, as it is associated with increased mortality, longer hospital stays, and cognitive decline, making systematic screening essential in high-risk populations such as elderly patients and those with dementia. Some key features to assess include:
- Acute onset and fluctuating course
- Inattention, which can be tested by asking the patient to recite months backward or perform digit span tests
- Disorganized thinking, which can be assessed by asking simple questions and observing for rambling or incoherent speech
- Altered level of consciousness, which can be evaluated using sedation scales to assess arousal level 1. It is essential to note that delirium is often missed in clinical settings, particularly the hypoactive subtype, making systematic screening essential in high-risk populations 1.
From the Research
Delirium Assessment Maneuvers
The following maneuvers are used to determine delirium:
- Clock Drawing Test (CDT) 2, 3
- Confusion Assessment Method (CAM) 4, 5, 6
- Delirium Rating Scale-Revised-98 (DRS-R-98) 4, 5
- Intensive Care Delirium Screening Checklist (ICD-SC) 6
- Nursing Delirium Screening Scale (Nu-DESC) 6
- Detecting Delirium Scale (DDS) 6
- Memorial Delirium Assessment Scale 3
- Bedside Confusion Scale 3
- NEECHAM confusion scale 5
- Delirium observation scale 5
- Pediatric Anesthesia Emergence Delirium scale 5
- Pediatric CAM-ICU 5
Characteristics of Delirium Assessment Scales
These scales have varying characteristics, such as: